Herbalism, Western

Definition

Western herbalism is a form of the healing arts that draws from herbal traditions of Europe and the Americas, and that emphasizes the study and use of European and Native American herbs in the treatment and prevention of illness. Western herbalism is based on physicians' and herbalists' clinical experience and traditional knowledge of medicinal plant remedies preserved by oral tradition and in written records over thousands of years. Western herbalism, like the much older system of traditional Chinese medicine, relies on the synergistic and curative properties of the plant to treat symptoms and disease and maintain health.

Western herbalism is based upon pharmocognosy, the study of natural products. Pharmocognosy includes the identification, extraction methods, and applications of specific plant constituents responsible for specific therapeutic actions, such as the use of digoxin from digitalis leaf for heart failure. These constituents are extracted, purified and studied in clinical research. They may be concentrated to deliver standardized, set doses. Sometimes, the natural constituent can be synthesized in the laboratory, or changed and patented. Practitioners may choose to use fresh medicinal plants, simple extracts, or standardized extracts.

In standardized extracts, a specific quantity of a constituent is called a marker compound, and it may or may not be the active constituent(s) in the plant medicine. The products should be produced under good manufacturing processes and according to the traditional National Formulary, the U. S. Dispensatory, or the U. S. Pharmacopeia.

Origins

Over 2,500 years ago Hippocrates wrote, "In medicine one must pay attention not to plausible theorizing

but to experience and reason together." This Greek physician and herbalist from the fourth century B.C. is considered the father of Western medicine. He stressed the importance of diet, water quality, climate, and social environment in the development of disease. Hippocrates believed in treating the whole person rather than merely isolating and treating symptoms. He recognized the innate capacity of the body to heal itself, and emphasized the importance of keen observation in the medical practice. He recommended simple herbal remedies to assist the body in restoring health.

Ancient Greek medicine around the fifth century B.C. was a fertile ground for contrasting philosophies and religions. Greek physicians were influenced by the accumulated medical knowledge from Egypt, Persia, and Babylon. Medical advances flourished and practitioners and scholars were free to study and practice without religious and secular constraints. In the fourth century B.C., Theophrastus wrote the Historia Plantarum, considered to be the founding text in the science of botany.

During the first century A.D. Dioscorides, a Greek physician who traveled with the Roman legions, produced five medical texts. His herbal text, known as the De Materia Medica, is considered to be among the most influential of all western herbal texts. It became a standard reference for practitioners for the next 1,500 years. This influential book also included information on medicinal herbs and treatments that had been used for centuries in Indian Ayurvedic medicine. Galen of Pergamum, who also lived in the first century A.D., was a Roman physician and student of anatomy and physiology. He authored a recipe book containing 130 antidotes and medicinal preparations. These elaborate mixtures, known as galenicals, sometimes included up to 100 herbs and other substances. This complex approach to herbal medicine was a dramatic change from the simple remedies recommended by Hippocrates and employed by traditional folk healers. Galen developed a rigid system of medicine in which the physician, with his specialized knowledge of complex medical formulas, was considered the ultimate authority in matters of health care. The Galenic system, relying on theory and scholarship rather than observation, persisted throughout the Middle Ages. The galenical compounds, along with bloodletting, and purging, were among the drastic techniques practiced by the medical professionals during those times; however, traditional herbal healers persisted outside the mainstream medical system.

During the eighth century a medical school was established in Salerno, Italy, where the herbal knowledge accumulated by Arab physicians was preserved. The Arabian Muslims conducted extensive research on medicinal herbs found in Europe, Persia, India, and the Far East. Arab businessmen opened the first herbal pharmacies early in the ninth century. The Leech Book of Bald, the work of a Christian monk, was compiled in the tenth century. It preserved important medical writings that had survived from the work of physicians in ancient Greece and Rome.

The Middle Ages in Europe were a time of widespread death by plagues and pestilence. The Black Plague of 1348, particularly, and other health catastrophes in later years, claimed so many lives that survivors began to lose faith in the dominant Galenic medical system. Fortunately, the knowledge of traditional herbal medicine had not been lost. Medieval monks who cultivated extensive medicinal gardens on the monastery grounds also patiently copied the ancient herbal and medical texts. Folk medicine as practiced in Europe by traditional healers persisted, even though many women herbalists were persecuted as witches and enemies of the Catholic Church and their herbal arts were suppressed.

The growing spice trade and explorations to the New World introduced exotic plants, and a whole new realm of botanical medicines became available to Europeans. Following the invention of the printing press in the fifteenth century, a large number of herbal texts, also simply called herbals, became available for popular use. Among them were the beautifully illustrated works of the German botanists Otto Brunfels and Leonhard Fuchs published in 1530, and the Dutch herbal of Belgian physician Rembert Dodoens, a popular work that was later reproduced in English. In 1597, the physician and gardener John Gerard published one of the most famous of the English herbals, still in print today. Gerard's herbal, known as The Herballor General Historie of Plantes was not an original work. Much of the content was taken from the translated text of his Belgian predecessor Dodoens. Gerard did, however, include descriptions of some of the more than one thousand species of rare and exotic plants and English flora from his own garden.

The correspondence of astrology with herbs was taught by Arab physicians who regarded astrology as a science helpful in the selection of medicines and in the treatment of diseases. This approach to Western herbalism was particularly evident in the herbal texts published in the sixteenth and seventeenth centuries. One of the most popular and controversial English herbals is The English Physician Enlarged published in 1653. The author, Nicholas Culpeper, was an apothecary by trade. He also published a translation of the Latin language London Pharmacopoeia into English. Culpeper was a nonconformist in loyalist England, and was determined to make medical knowledge more accessible to the apothecaries, the tradesmen who prescribed most of the herbal remedies. Culpeper's herbal was criticized by the medical establishment for its mix of magic and astrology with botanical medicine, but it became one of the most popular compendia of botanical medicine of its day. Culpeper also accepted the so-called "Doctrine of Signatures," practiced by medieval monks in their medicinal gardens. This theory teaches that the appearance of plants is the clue to their curative powers. Plants were chosen for treatment of particular medical conditions based on their associations with the four natural elements and with a planet or sign. The place where the plant grows, its dominant physical feature, and the smell and taste of an herb determined the plant's signature. Culpeper's herbal is still in print in facsimile copies, and some pharmocognosists and herbalists in the twenty-first century voice the same criticisms that Culpeper's early critics did.

European colonists brought their herbal knowledge and plant specimens to settlements in North America, where they learned from the indigenous Americans how to make use of numerous nutritive and medicinal plants native to the New World. Many European medicinal plants escaped cultivation from the early settlements and have become naturalized throughout North America. The first record of Native American herbalism is found in the manuscript of the native Mexican Indian physician, Juan Badianus, published in 1552. The American folk tradition of herbalism developed as a blend of traditional European medicine and Native American herbalism. The pioneer necessity for self-reliance contributed to the perseverance of folk medicine well into the twentieth century.

In Europe in the seventeenth century, the alchemist Paracelsus changed the direction of Western medicine with the introduction of chemical and mineral medicines.

He was the son of a Swiss chemist and physician. Paracelsus began to apply chemicals, such as arsenic, mercury, sulfur, iron, and copper sulfate to treat disease. His chemical approach to the treatment of disease was a forerunner to the reliance in the twentieth century on chemical medicine as the orthodox regimen treatment prescribed in mainstream medical practice.

The nineteenth and twentieth centuries brought a renewed interest in the practice of western herbalism and the development of natural therapies and health care systems that ran counter to the mainstream methods of combating disease symptoms with synthetic pharmaceuticals.

In the late eighteenth century, the German physician Samuel Hahnemann developed a system of medicine known as homeopathy. This approach to healing embraces the philosophy of "like cures like." Homeopathy uses extremely diluted solutions of herbs, animal products, and chemicals that are believed to hold a "trace memory" or energetic imprint of the substance used. Homeopathic remedies are used to amplify the patient's symptoms with remedies that would act to produce the same symptom in a healthy person. Homeopathy holds that the symptoms of illness are evidence of the body's natural process of healing and eliminating the cause of the disease.

In 1895, the European medical system known as naturopathy was introduced to North America. Like homeopathy, this medical approach is based on the Hippocratic idea of eliminating disease by assisting the body's natural healing abilities. The naturopath uses nontoxic methods to assist the body's natural healing processes, including nutritional supplements, herbal remedies, proper diet, and exercise to restore health.

Western herbalism is regaining popularity at a time when the world faces the stress of overpopulation and development that threatens the natural biodiversity necessary for these valuable medicinal plants to survive. The American herb market is growing rapidly and increasing numbers of individuals are choosing alternative therapies over mainstream allopathic Western medicine. It is projected that by the year 2002 consumers will spend more than seven billion dollars a year on herbal products.

Though research into the efficacy and safety of traditional herbal remedies is increasing, it has been limited by the high costs of clinical studies and laboratory research, and by the fact that whole plants and their constituents are not generally patentable (therefore, there is no drug profit after market introduction). Outside the United States, herbalism has successfully combined with conventional medicine, and in some countries is fully integrated into the nations' health care systems. At the beginning of the twenty-first century, 80% of the world's population continues to rely on herbal treatments. The World Health Organization promotes traditional herbal medicine for treatment of many local health problems, particularly in the Third World, where it is affordable and already well integrated into the cultural fabric.

In the United States, the re-emergence in interest in holistic approaches to health care is evident. Citizens are demanding access to effective, safe, low-cost, natural medicine. Legislative and societal change is needed, however, before natural therapies can be fully integrated into the allopathic health care system and provide citizens with a wide range of choices for treatment. If the current trend continues, U. S. citizens will benefit from a choice among a variety of safe and effective medical treatments.

Benefits

The benefits of botanical medicine may be subtle or dramatic, depending on the remedy used and the symptom or problem being addressed. Herbal remedies usually have a much slower effect than pharmaceutical drugs. Some herbal remedies have a cumulative effect and work slowly over time to restore balance, and others are indicated for short-term treatment of acute symptoms. When compared to pharmaceutical drugs, herbal remedies prepared from the whole plant have relatively few side effects. This characteristic is due to the complex chemistry and synergistic action of the full range of phytochemicals present in the whole plant, and the relatively lower concentrations. They are generally safe when used in properly designated therapeutic dosages, and less costly than the isolated chemicals or synthetic prescription drugs available from western pharmaceutical corporations.

Description

Herbs are generally defined as any plant or plant part that may be used for medicinal, nutritional, culinary, or other beneficial purposes. The active constituents of plants (if known) may be found in varying amounts in the root, stem, leaf, flower, and fruit, etc. of the plant. Herbs may be classified into many different categories. Some Western herbalists categorize herbal remedies according to their strength, action, and characteristics. Categories may include sedatives, stimulants, laxatives, febrifuges (to reduce fever), and many others. One system of classification is based on a principle in traditional Chinese medicine that categorizes herbs into four classes: tonics, specifics, heroics, or cleansers and protectors. Within these broad classifications are the numerous medicinal actions of the whole herb, which may be due to a specific chemical or combination of chemicals in the plant.

Tonics. Herbs in this classification are also known as alteratives in western herbalism. They are generally mild in their action and act slowly in the body, providing gentle stimulation and nutrition to specific organs and systems. Tonic herbs act over time to strengthen and nourish the whole body. These herbs are generally safe and may be used regularly, even in large quantities. These tonic herbs are known as "superior" remedies in traditional Chinese medicine. The therapeutic dose of tonic remedies is far removed from the possible toxic dose. American ginseng is an example of a tonic herb.

Specifics. Herbs in this classification are strong and specific in their therapeutic action. They are generally used for short periods of time in smaller dosages to treat acute conditions. Herbs classified as specifics are not used beyond the therapeutic treatment period. Echinacea is a specific herb.

Heroic. These herbs offer high potency but are potentially toxic, and should not be used in self-treatment. Because the therapeutic dosage may be close to the lethal dosage, these herbs are presented cautiously and closely monitored or avoided by trained clinicians. They should not be used continuously or without expert supervision. Poke (Phytolacca americana) is an example of a heroic remedy.

Cleansers and protectors. These herbs, plants, and plant tissues remove wastes and pollutants, while minimally affecting regular body processes. An example of a cleanser is pectin. Pectins are the water-soluble substances that bind cell walls in plant tissues, and some researchers believe that they help remove heavy metals and environmental toxins from the body.

Preparations

Herbal preparations are commercially available in a variety of forms, including tablets or capsules, tinctures, teas, fluid extracts, douches, washes, suppositories, dried herbs, and many other forms. The medicinal properties of herbs are extracted from the fresh or dried plant parts by the use of solvents appropriate to the particular herb. Alcohol, oil, water, vinegar, glycerin, and propylene glycol are some of the solvents used to extract and concentrate the medicinal properties. Steam distillation and cold-pressing techniques are used to extract the essential oils. The quality of any herbal remedy and the potency of the phytochemicals found in the herb depend greatly on the conditions of weather and soil where the herb was grown, the timing and care in harvesting, and the manner of preparation and storage.

Precautions

Herbal remedies prepared by infusion, decoction, or alcohol tincture from the appropriate plant part, such as the leaf, root, or flower, are generally safe when ingested in properly designated therapeutic dosages. However, many herbs have specific contraindications for use when certain medical conditions are present. Not all herbal remedies may be safely administered to infants or small children. Many herbs are not safe for use by pregnant or lactating women. Some herbs are toxic, even deadly, in large amounts, and there is little research on the chronic toxicity that may result from prolonged use. Herbal remedies are sold in the United States as dietary supplements and are not regulated for content or efficacy. Self-diagnosis and treatment with botanical medicinals may be risky. A consultation with a clinical herbalist, naturopathic physician, or certified clinical herbalist is prudent before undertaking a course of treatment.

Essential oils are highly concentrated and should not be ingested as a general rule. They should also be diluted in water or in a non-toxic carrier oil before application to the skin to prevent contact dermatitis or photo-sensitization. The toxicity of the concentrated essential oil varies depending on the chemical constituents of the herb.

An American professor of pharmacognosy, Varro E. Tyler, believes that "herbal chaos" prevails in the United States with regard to herbs and phytomedicinals. In part he blames the herb producers and marketers of crude herbs and remedies for what he terms unproven hyperbole, poor quality control, deceptive labeling, resistance to standardization of dosage forms, and continued sale of herbs determined to be harmful.

A new warning about Western herbalism has been made necessary by technology. The Internet has a number of sites available with unregulated and often unhealthy advice about use of herbal remedies. Many herbalists and allopathic physicians urge patients to use caution when seeking Internet information on herbal treatments. One cancer-related study found that only 36% of the web sites found in a search offered information that complied with regulatory guidelines about unsubstantiated claims about treatment or cure of disease.

Side effects

Herbs contain a variety of complex phytochemicals that act on the body as a whole or on specific organs and systems. Some of these chemical constituents are mild and safe, even in large doses. Other herbs contain chemicals that act more strongly and may be toxic in large doses or when taken continuously. Drug interactions are possible with certain herbs when combined with certain pharmaceutical drugs. Some herbs are tonic in a small amount and toxic in larger dosages.

In 2002, a report to the American Academy of Pediatrics cautioned members to watch for signs of adverse effects to the cardiovascular system of children from certain herbal remedies that are often not revealed by their families. For example, ephedra causes increases in heart rate and blood pressure. Other examples of child and adolescent patients with heart complications from herbs given to them that their parents assumed would be harmless were given by the presenter. Another report said that even adult patients fail to inform their physicians about herbal products they are using, and that patients do not think of them as medicines. Yet many herbal products can interact with allopathic medicines and either cancel their effects or cause adverse effects. For example, garlic, ginseng, ginkgo, feverfew, licorice, and other common remedies have anticoagulant properties that can put patients as risk of bleeding during surgery.

Research & general acceptance

Western herbalism is experiencing a revival of popular and professional interest. The number of training schools and qualified herbal practitioners is growing to meet the demand. Western herbalism is incorporated into the medical practice of licensed naturopathic doctors, who receive special training in clinical herbalism. Folk herbalists, heir to the continuing oral traditions passed from generation to generation in many rural areas, as well as amateur self-taught herbalists, keep the practice of botanical medicine alive at the grassroots level. Traditional Western herbalism relies on traditional use and materia medica, folk wisdom, and recent clinical research and advances in the extraction processes. These advances provide increased quality control on the concentration and potency of the active ingredients. Western physicians, educated in allopathic medicine, typically receive no training in the use of herbs. These doctors rely on pharmaceutical drugs for their patients, and some cite the following reasons for continuing to do so: lack of standardized dosages, lack of quality control in the preparation of herbal medicinals, and the dearth of clinical research verifying the safety and effectiveness of many traditional herbal remedies.

Herbalism is widely practiced throughout Europe, particularly in England, France, Italy, and Germany, where phytomedicinals are available in prescription form and as over-the-counter remedies. In Germany, plant medicines are regulated by a special government body known as the Commission E. In the United States, however, despite increasing popularity, traditional herbalism is not integrated into the allopathic medical system. Phytomedicinals are sold as dietary supplements rather than being adequately researched and recognized as safe and effective drugs. The Dietary Supplement Health and Education Act of 1994 circumvented a U. S. Food and Drug Administration (FDA) effort to effectively remove botanicals from the marketplace and implement regulations restricting sale. Massive popular outcry against the proposed regulations on the sale of herbs and phytomedicinals resulted in this Congressional action. In 2000, U.S. President Bill Clinton, by executive order, created the White House Commission on Alternative Medicine in an effort to hold alternative medicine therapies "to the same standard of scientific rigor as more traditional health care interventions." That commission is charged with recommending federal guidelines and legislation regarding the use of alternative medical therapies in the twenty-first century.

Training & certification

In the United States, courses of study in Western herbalism are available in almost all 50 states. The study of traditional herbalism is part of the course curriculum in Naturopathic medical colleges that offer four-year degree programs leading to licensure as a Doctor of Naturopathy. The oldest of these institutions is the National College of Naturopathic Medicine, established in 1956. Western clinical herbalism is taught through a growing number of institutions and organizations offering training and certification through residential and apprenticeship programs, and by correspondence. Some programs are comprehensive, with curricula in physiology, clinical diagnosis and treatment, ethnobotany, pharmacognosy, phytotherapy, plant identification, ethical wildcrafting and cultivation, and preparation and application of herbal remedies. Other programs are brief, geared more to the amateur herbalist and gardener. The Southwest School of Botanical Medicine in Bisbee, Arizona, is one of the oldest herbal schools, established in 1978. No licensing body yet exists in the United States to regulate the practice of herbal medicine.

In the United States herbal remedies are sold as dietary supplements. They are not regulated as to content and efficacy, and few are prepared in standardized dosages. Many of the supplements commercially available base claims for efficacy on traditional use and anecdotal evidence that has not been duplicated by clinical studies. In Germany, Commission E evaluates the safety and efficacy of the 300 herbs and herb combinations sold in that country. No equivalent regulatory commission exists in the United States. Permits are required in some states for the wildcrafting of rare and endangered herbs, such as goldenseal and American ginseng, two commercially valuable herbs in high demand in the growing medical botanicals industry.